Strabismus

Family Doctor Logo

What is strabismus?

Strabismus is an eye disorder. It affects the muscle control in your eyes. The eyes don’t line up properly. Instead, the eyes appear to cross, or one eye may wander to the side. One eye’s vision becomes weaker. This disorder also is called “crossed eyes.” If it is not fixed when a child is young, his or her brain will always ignore what it sees from the weak eye.

Symptoms of strabismus

Symptoms can include:

  • Crossed eyes
  • Double vision
  • Wandering eyes
  • Eyes that don’t point in the same direction
  • Loss of vision or depth perception
  • When your child closes one eye to see with the other
  • When your child turns his or her head to one side to see

Symptoms may be present all the time, or may come and go. It’s normal for newborn babies to have eyes that cross or wander. It happens more when they are tired. If your child is older than 3 months of age, tell your doctor if you see notice symptoms.

What causes strabismus?

There are six muscles around each eye. When these muscles don’t work together, each eye sees different things. This confuses the brain. The brain learns to focus on the image from the stronger eye.

In most children with strabismus, the cause is unknown. More than half the time, the problem is present at or shortly after birth. This is called congenital strabismus.

Some disorders associated with strabismus in children include:

  • Apert syndrome
  • Cerebral palsy
  • Congenital rubella
  • Hemangioma near the eye as a baby
  • Incontinentia pigmenti syndrome
  • Noonan syndrome
  • Prader-Willi syndrome
  • Retinopathy of prematurity
  • Retinoblastoma
  • Traumatic brain injury
  • Trisomy 18

Strabismus that develops in adults can be caused by:

  • Botulism
  • Diabetes
  • Graves disease
  • Guillain-Barré syndrome
  • Injury to the eye
  • Shellfish poisoning
  • Stroke
  • Traumatic brain injury
  • Vision loss from any eye disease or injury

A family history of strabismus is a risk factor. Farsightedness may be a contributing factor in children.

How is strabismus diagnosed?

Your doctor will do a physical exam. This will include checking the eyes. The eye exam may include the following tests:

  • Corneal light reflex
  • Cover/uncover test
  • Retinal exam
  • Standard ophthalmic exam
  • Visual acuity
  • A brain and nervous system exam.

Can strabismus be prevented or avoided?

This disorder cannot be prevented or avoided.

Strabismus treatment

Treatment is important. If not treated, the weaker eye will never see well. Treatment can help your child have normal vision. The earlier the treatment starts, the better.

Treatment focuses on making the weak or wandering eye stronger. This could involve wearing corrective glasses or an eye patch. Putting eye drops in the “good” eye can make the weak eye stronger. Treatment can temporarily affect vision in both eyes.

Some children need surgery. Surgery is a last resort. Surgery is simple, but it doesn’t always make the eyes perfectly straight. Sometimes surgery has to be repeated later.

Treating early makes it easier to fix the condition. Treatment will go on for months or even a few years. Your child may have to wear his or her eye patch less over time. The same is true for eye drops.

Living with strabismus

When surgery is necessary, the result isn’t always perfect. Vision problems can remain. The child may still have reading problems in school. Adults may have a hard time driving. Vision may affect the ability to play sports.

Permanent vision loss in one eye may occur if treatment is delayed. If amblyopia is not treated by about age 11, it is likely to be permanent. About one-third of children with strabismus will develop amblyopia. Amblyopia is loss of vision.

Questions to ask your doctor

  • Are there certain eye exercises you can do to help?
  • How many hours a day do you have to wear an eye patch?
  • Does this condition cause kids or adults to become dizzy?
  • If one child has it, are other children at higher risk?
  • If treatment is successful, will my child have vision problems later in life?